ABSTRACT
For 20 years, female sterilization has been increasing in popularity as a contraceptive method in Costa Rica. However, contraceptive sterilization has never been allowed explicitly under Costa Rican law. In 1976 the Costa Rican National Assembly instituted more stringent guidelines regarding medical sterilizations in order to eliminate contraceptive sterilizations, which had been occurring under relatively loose interpretations of national policy. Data from the 1976 National Fertility Survey and the 1981 Contraceptive Prevalence Survey indicate that the change in policy had only a short-term effect. Period sterilization rates fell substantially after 1976 but rebounded considerably by 1980, and the estimate of the proportion of married women who will ultimately be sterilized was approximately .5 for the periods both before and after 1976.
PIP: There has been a rapid decline in fertility in Costa Rica in the past 2 decades as a result of dramatic increases in the use of contraceptives, female sterilization being one of the most popular. The objection of certain groups to contraceptive sterilization was responsible for a change in procedures designed to eliminate sterilization for contraceptive purposes. However the enforcement of this policy has had little or no long term effect since medical versus contraceptive indications for the procedure cannot be defined precisely, and surgical sterilization for medical reasons is an important part of any modern health program for women. Other examples of government effort to eliminate access to certain forms of contraception or to reverse fertility declines, especially Eastern European countries such as limiting the availability of abortion, have had only very short-lived impact on birth rates. Romania provides the most striking example. In 1966, before stringent regulations in regard to abortion went into effect, the abortion ratio per 1000 live births was 3050; in 1967 it was 333, when abortion was legally limited to women over 45; or women having 4 or more children; or with specific medical indications. But the ratio increased to a level close to 1000 by 1972; abortions were being performed more frequently on the grounds of adverse mental health consequences, which were classified as a medical indication. The general conclusion from the cases cited in this paper is that once low fertility norms are widely accepted in a society that is accustomed to access to the effective contraception needed to fulfill those norms, the ability of a government to restrict access to certain methods of contraception is substantially limited. Studies of family planning in developing countries show that the task of initiating a fertility decline is very difficult as high fertility norms are deeply integrated into social systems and not easy to dislodge. However, once low fertility norms and associated behavior are firmly established, they are equally difficult to dislodge.